The knowledge desired by emergency medical service managers of their ambulance clinicians – A modified Delphi study

AimThe aim of the study was to identify the types of knowledge that Swedish Emergency Medical Service (EMS) managers considered desirable in their Ambulance Clinicians.BackgroundEmergency medical service managers are responsible for organisational tasking and in this are dependent on the knowledge possessed by their ambulance clinicians. It would therefore be of value to explore EMS managers’ approach to this knowledge.DesignA modified Delphi method in three rounds.MethodsIn total thirty-six EMS managers participated, and twenty-four finished all three rounds. They were encouraged to rate each sub-category, and the ten with the highest mean were interdependently ranked in the final round.ResultsFive categories and twenty-six sub-categories emerged in the first round, covering knowledge related to; contextual aspects, medical and holistic assessments, formal education and organisational issues. Eventually, the sub-category ‘Knowledge to assess the patient’s situation from a holistic perspective’ was the highest ranked, followed by ‘Medical knowledge to assess and care for different diseases’ and ‘Knowledge to be able to care for critically ill patients’.ConclusionsTaken together the knowledge areas address essentially medical care, contextual aspects and nursing. The boundaries between these can sometimes be seen as elusive, calling for ambulance clinicians to balance these areas of knowledge.     

护理人员职业心理素质的塑造

随着我国经济体制改革进一步的深化和社会的不断进步,当前对护理人员的职业心理素质的要求也在不断的提高,社会对护理人员的职业心理素质也有着越来越广泛的关注。本文从护理人员职业心理素质缺失的原因和培养途径两个方面进行论述。     

O papel do videolaringoscópio em programas de treinamento de intubação endotraqueal

Background

Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education.

Preventing EMS workplace violence: A mixed-methods analysis of insights from assaulted medics

ObjectiveTo describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel.MethodsThis mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented.ResultsOf 1778 survey respondents, 633 reported being assaulted in the previous 12 months; 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon’s Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness; Equipment factors, such as restraint equipment and resources; and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methodsConclusionsThis is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience.     

Quick epinephrine administration induces favorable neurological outcomes in out-of-hospital cardiac arrest patients

Objective

This research is to study if quick administration of adrenaline on OHCA prior to hospitalization has an effect on improving CPC1-2 at one month.

A comparison of ambulance responses to incidents of Medical Emergency Teams led by nurses and paramedics––A retrospective single-center study

Background

In Poland there are currently two main types of Medical Emergency Team: basic, run by nurses or paramedics, and specialist, led by physicians. They differ not only in professional qualifications but also in their terms of reference.

Objectives

We compared the responses to incidents of Medical Emergency Teams led by nurses and paramedics, in terms of the frequency of pharmacotherapy use and medical rescue activities.

Study design

Ambulance call reports.

Settings

Medical Emergency Teams in Eastern Poland.

Participants

Medical Emergency Teams led by nurses or paramedics. Exclusion criteria were cancelation of calls by the dispatcher, calls with no patient on the scene, and neonatal and interhospital transportation.

Methods

A retrospective analysis of ambulance call reports. A comparison of actions of nurses and paramedics taken in the field, and decisions concerning transportation of the patient to a hospital or leaving the home were collected.

Results

Of 1115 Medical Emergency Teams calls, those led by paramedics (60.5%) were more common. Paramedics, more often than nurses, provided aid solely in the field—27.5% and 16.0%, respectively—and less frequently transported patients to the hospital—38.5% and 50.7%, respectively. Significant differences in administration of oxygen therapy and analgesics were identified; paramedics used them more often than nurses. Paramedics used cervical collars, 3.6% and 1.1% (p = 0.01), respectively, and performed 12-lead electrocardiograms, 4.7% and 1.4% (p = 0.002), respectively, significantly more frequently than did nurses.

Conclusions

Despite the comparable competency of paramedics and emergency nurses in Poland, Medical Emergency Teams’ activities varied depending on whether a nurse or a paramedic was the team leader. It is recommended that further in-depth research is conducted in this area.     

Science and Art at the Bedside

Abstract

Paramedics are increasingly seen as an integral component of health systems in high income countries. This editorial discusses the factors driving the evolution of paramedicine and the role paramedics may play in the delivery of community-based palliative care. The challenges facing paramedics in palliative care contexts are reviewed briefly. Ultimately, this editorial argues that paramedics are important stakeholders in the delivery of community-based palliative care and have been a notable omission in health service policy and planning.